Corticotherapy Versus Adrenocorticotrophic Hormone for the Treatment of West Syndrome: a Systematic Review and Meta-analysis
Elizabeth de Farias1, Altair de Melo Neto1, Aishwarya Koppanatham2, Julia Cappi Aguiar Moraes Souza3, Raphael Besborodco4, Gabrielle de Souza Rocha1
1Federal University of Roraima, 2Andhra Medical College, 3University of Rio Verde, 4NYU
Objective:
The objective was to present an updated review comparing the therapeutic and adverse effects of adrenocorticotropic hormone (ACTH) therapy versus corticosteroids in children with Infantile Spasms.
Background:
Although it is known that the most commonly used therapies for West Syndrome are intramuscular ACTH and oral prednisolone, there is still controversy in the literature regarding the equivalence of their effects. The importance of elucidating the superiority of one drug over the other lies in the difference in their costs.
Design/Methods:
PubMed, EMBASE, and Cochrane Central were used as search tools. The outcomes of interest selected were spasm cessation on day 14 of therapy, cessation of hypsarrhythmia and adverse effects such as weight gain, infection, irritability, and hypertension. Statistical analysis was performed using RevMan 5.1.7.
Results:
1,998 articles were screened and 7 RCTs and 429 patients were included. Compared with Corticoids, ACTH was associated with a bigger reduction in weight gain (RR 1.41; 95% CI 1.01 - 1.97; p=0.04; I²=0%). There was no significant difference in cessation of spasms on day 14 (OR 0.91; 95% CI 0.47 - 1.47; p=0.79), hypsarrhythmia (OR 0.97; 95% CI 0,22 - 4.34), irritability (RR 0.78; 95% CI 0.30 - 1.99), hypertension (RR 0.64; 95% CI 0.35 - 1.15; p=0.14), and infection (RR 0.69; 95% CI 0.19 - 2.50; p=0.57).
Conclusions:
This study provides robust evidence regarding the safety and efficacy of ACTH or corticoids in children with epileptic spasms. However, the significant heterogeneity between studies restricts the analysis, emphasizing the necessity for additional research to assess the best option to treat infantile spasms.
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